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Use of health services by preschool-aged children who are developmentally vulnerable and socioeconomically disadvantaged: testing the inverse care law
  1. Sue Woolfenden1,2,
  2. Claire Galea3,4,
  3. Hannah Badland5,
  4. Hayley Smithers Sheedy3,4,
  5. Katrina Williams6,
  6. Anne M Kavanagh7,
  7. Dinah Reddihough8,9,
  8. Sharon Goldfeld10,11,
  9. Raghu Lingam2,
  10. Nadia Badawi3,4,
  11. Meredith O'Connor10
  1. 1Department of Community Child Health, Sydney Children’s Hospital Network, Randwick, New South Wales, Australia
  2. 2Population Child Health Group, Discipline of Paediatrics, University of New South Wales, Sydney, New South Wales, Australia
  3. 3Cerebral Palsy Alliance, The University of Sydney, Sydney, New South Wales, Australia
  4. 4Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia
  5. 5Centre for Urban Research, RMIT University, Melbourne, Victoria, Australia
  6. 6Department of Paediatrics, Monash University, Clayton, Victoria, Australia
  7. 7Centre for Health Equity, The University of Melbourne, Melbourne, Victoria, Australia
  8. 8Neurodisability and Rehabilitation, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
  9. 9Department of Developmental Medicine, The Royal Children’s Hospital, Melbourne, Victoria, Australia
  10. 10Policy and Equity, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
  11. 11Centre for Community Child Health, The Royal Children’s Hospital, Parkville, Victoria, Australia
  1. Correspondence to Dr Sue Woolfenden, Department of Community Child Health, Sydney Children’s Hospital Network, Randwick, NSW 2031, Australia; susan.woolfenden{at}health.nsw.gov.au

Abstract

Aim The inverse care law suggests that those with the greatest need for services are least likely to receive them. Our aim of this study was to test the inverse care law in relation to the use of health services by children aged 4–5 years in Australia who were developmentally vulnerable and socioeconomically disadvantaged.

Method Cross-sectional data were collected from the Longitudinal Study of Australian Children birth cohort when the children were aged 4–5 years. Children were grouped according to the combination of developmental vulnerability (yes, no) and socioeconomic disadvantage (lower, higher), resulting in four groups (reference group: developmentally vulnerable and disadvantaged). Multivariate regression was used to examine the impact of the combination of developmental vulnerability and disadvantage on health service use, adjusting for other sociodemographic characteristics.

Results 3967 (90%) of children had data on developmental vulnerability at 4–5 years. A third of children (32.6%) were classified as developmentally vulnerable, and 10%–25% of these children had used health services. Non-disadvantaged children who were developmentally vulnerable (middle need) had 1.4–2.0 times greater odds of using primary healthcare, specialist and hospital services; and non-disadvantaged children who were not developmentally vulnerable (lowest need) had 1.6–1.8 times greater odds of using primary healthcare services, compared with children who were developmentally vulnerable and disadvantaged (highest need).

Conclusion We found some evidence of the inverse care law. Equity in service delivery remains a challenge that is critically important to tackle in ensuring a healthy start for children.

  • paediatric
  • child health
  • social inequalities
  • disability
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Footnotes

  • Twitter Sue Woolfenden @WoolfendenSusan

  • Contributors SW planned, conducted (including acquisition and analysis of data) and reported the work described in the article and was responsible for the overall content as guarantor. CG, MOC, HB, SG and AMK contributed to study planning, data analysis plan and interpretation of results. RL, KW, DR, NB and HSS reviewed and gave content, editorial and methodological advice on drafts of the initial manuscript. All authors (SW, CG, HB, HSS, RL, NB, DR, KW, AMK, MOC) were involved in revising the manuscript critically for important intellectual content and have given final approval of the version to be published.

  • Funding SW is supported by the National Health and Medical Research Council Career Development Fellowship (1158954) and the Research Foundation of Cerebral Palsy Alliance. HSS is supported by the National Health and Medical Research Council Early Career Fellowship (1144566) and the Australasian Cerebral Palsy Clinical Trials Network. SG is supported by the National Health and Medical Research Council of Australia Practitioner Fellowship (1155290). Research at the MCRI is supported by the Victorian Government’s Operational Infrastructure Support Program. HB is supported by an RMIT University Vice Chancellor’s Senior Research Fellowship.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was granted to conduct this study by the Human Research Ethics Committee, Royal Children’s Hospital (approval number 24051).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. All data used in this manuscript are available from the Longitudinal Study of Australian Children (https://growingupinaustralia.gov.au/).

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